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Diabetes mellitus, dyslipidemia and hypertension
AJH-APRIL 1996-VOL. 9, NO.4, PART 2
POSTERS: ainical Trials
G17
GIS
DIABRTES MF.LLITUS,DYSLIPIDEMIA AND HYPFR~ENSION. A.L.Greco, S.F.Greco. ~edical Department B.Ramazzini ~ospital, Carpi (~odena) - Italy From 1 0 90 to 1993 at the Antidiabetia Center of our Medical Department 867 ~ta ~et1.,patients have been osserved; 1?) were males (18.8~) with a mean age of 61 years and 444 were females (SI.2d ) with a mean age of 6, years. Diabetes Type I was observed in l ' patients (,.2~), diabetes ~pe II in 8?2 patients (04.8). 624 patients were obese (72~). ffypertensian was diagnosed .in 10, cases (16.7 d ). Hypertension preceeded diabetes in 116 patients (R3%) while diabetes precee~e~ hyp0rtension in 6° cases (171). HYpertension was ~ignose~ in 6~ of females an~ in 4~ of males. Diabetics with alteratio n of lipid metabolism were 100 (11.6~'. S7/100 (l~) had hypercolesterolemia type II of Fredrtckson,II7 (39%) had hypertrigliceri~emia (type IV) and I?6 had d;tslipidemia type lIB" (421). In this group of 300 patients hypertension was present in 1,1 cases ('I~). In 40, patients with ~iabetes and hypertension, obesity was present in l?I cases (7a.2~); Conclusion:thc great fre~uency of the association of ~iabetps,dyslipi~emia an~ hypertension c~n probably lea~ to a nega~ tive reciprocal interacti0n. KeyWords: ~inbetes, ~yclipi~emia, hypf'rt ensi On
RESULTS OF THE EUREVIE STUDY: COMPARISON OF PIRETANIDE AND THIAZIDES IN MILD TO MODERATE HYPERTENSIVE PATIENTS -J-P Flllastre1, 0 Vasmant 2, M Lievre 3, 0 Charensonney2, L. lIon3, J·P. Bo,ssel3,J-P. Grunfeld4
GI9 OSCILLATORY INDEX OF ELECTRORETINOGRAM (01) IS CORRELATED WITH LEFT VENTRICULAR THICKNESS IN YOUNG UNTREATED HYPERTENSIVE PATIENTS. E. Bocin, A. Coscnzl, A. Sacerdote, R. Molino, ·N.Solimano,
uM.Zecchin, G. Bellini. Istituto di Medicina Clinica, ·Eye Clinic and ··Divlsion of Cardiology. Univenity of Trieste. ITALY
The authors have previously demonstrated that the 01 is early reduced in borderline hypertensive patients without retinal changes observed Ihrough fundoschopy. The aim of Ihis study has been 10 investigate whelher these changes are related with left ventricular hypertrophy. a recognised fcature of targel organ mvolvement in hypertension. Nme untreated borderline hypertensive patients (age 2UI yrs) were admilled to this sludy All subjects had at least three omce blood pressure measurement within one month, to confirm Ihe diagnOSIs of hypertenSIon. Silting blood pressure was measured for statlsllcal evaluallon with a mercury sphygmomanomeler after IOmln res\. Oseillalory potentials of electrorelinogram were recorded afier IS min rellnal mesopic adaptation. 01 was calculated by adding Ihe amplitudes of the wavwlels 01. 02 and 03 within the b wave of electroretmogram The Ihickness of the septum (LVS) and Ihe posterior wall (LVPW) of len ventricle was measured by means of M-mode and B-mode echoeardiography. Results are reponed as mean ± standard deviation: SBP(mmHg) DBP(mmHg) LVS (mm) LVPW(mm) OI(IlV) 133±6
90±~
1±O.2
09±O.2
92±23
An inverse relallon of 01 has been demonslrated with the thickness of both LVS (R= .0 705. p=O.03) and LVPW (R=oO 777. p. 0.01) by means of linear regression tes\. These results demonstrate that 01 are not only early decreased in young hypenenslVe pallents but are also strenghtly correlated with left venlrlcular Ihickness. a recogntsed marker of cardiac mvolvement in hypertension. playing a great prognostic role.
Key Words: hypenrophy.
hypertension, electroretinogram, left ventricular
1 HOpIIaI ell IloIsguiIalnl6-Nancy , 2 LaborIIOhs _-Paris, 3 SPC H6pItSI
Can1Ioioglqut-Lyon, 4 H6p,lal Necker·Pans
To compare the new loop-dlurelic piretanide 6 mg LP (PIR) with hydrochlorothiazide (HCT) 2S mg and a fixed combination altlzldespllonolactone (ALTISP) on the treatment 01 hypertenSion DeSign and methods: The study was conducted by 296 general practitioners (Gps) coordinated by 48 nephrolog'sts and 8 seOior Gps. Eleven hundred and ftve pat,ents wrth mild to moderale hypertensIOn entered a 3 week placebo runOing penod and 899 were randomIZed 11 a 6 month. double-blind, parallel group active treatmant penod. FolloWlng tha protocol reqUirements, HCT and ALT/SP were compared only w,th PIR USWlg the Dunnett's (continuous vanables) or chi-square (calegoncaJ vanables) tests !lmlIa: Pabent eharactenstlcs at OnclUSIOll were the foDOWIng: male 42%, mean age 56±12 years, systolic blood pressura (SBP) 166±13 mmHg, diastolic blood pressure (DBP) 101±6 mmHg. The 3 study groups were fairly comparable at base Ine No Slgnnicant difference was found between the groups tor the overall quellty of Ide. Changes (a) il main parameters between IncluSion and 1st (Ml) or 6th (M6) month VISits ere given in the teble PIR n =288 HCT n = 300 ALTISP n = 291 ·16.2 ± 13.3 -ISHii.8 -197 ± 12.2' aSBP Ml -20.7 ± 14.4 -20.1 ±13.0 -24.1 ±13.0' (mmHg) M6 -103±8.1 -109± 77 -12.1 ±7S' aDBP Ml -141±8.S -13.7 ±8.S -ISSi8.1 (mmHg) M6 to.002 ± 0.37 .0.27 ± 040" 0010±0.40" a Potassium Ml to.02 ± 0.42 .0.22 ± 047' 0004± 0.47 (mmofll) M6 -10.9 H7 -1.6± 10.8 -12.1 ±t.s' a Serum creatlnlllO Ml t11±104 t4.9± 133' tl0±13 blmolll) M6 Serum creatmlna 12" >120 Ilmofll (n) Ml ~.
M.mcnIl
·p.OOO5"p=O.Ol
For the !a11e anlihypertenslve effect, potassium concentration did not change il the PIR group, whereas it decreased il the HCT group. The fall il blood pressure were greater lithe ALT/SP than ilthe PIR group, but at the expense of 1r1 oncrease il serum creatinine. ~:
Key Words:
Clinical trials, antihypertensive drug Ireatment, loop diuretic, thiazides, potassium
123A
POSTERS: ainical Trials
G17
GIS
DIABRTES MF.LLITUS,DYSLIPIDEMIA AND HYPFR~ENSION. A.L.Greco, S.F.Greco. ~edical Department B.Ramazzini ~ospital, Carpi (~odena) - Italy From 1 0 90 to 1993 at the Antidiabetia Center of our Medical Department 867 ~ta ~et1.,patients have been osserved; 1?) were males (18.8~) with a mean age of 61 years and 444 were females (SI.2d ) with a mean age of 6, years. Diabetes Type I was observed in l ' patients (,.2~), diabetes ~pe II in 8?2 patients (04.8). 624 patients were obese (72~). ffypertensian was diagnosed .in 10, cases (16.7 d ). Hypertension preceeded diabetes in 116 patients (R3%) while diabetes precee~e~ hyp0rtension in 6° cases (171). HYpertension was ~ignose~ in 6~ of females an~ in 4~ of males. Diabetics with alteratio n of lipid metabolism were 100 (11.6~'. S7/100 (l~) had hypercolesterolemia type II of Fredrtckson,II7 (39%) had hypertrigliceri~emia (type IV) and I?6 had d;tslipidemia type lIB" (421). In this group of 300 patients hypertension was present in 1,1 cases ('I~). In 40, patients with ~iabetes and hypertension, obesity was present in l?I cases (7a.2~); Conclusion:thc great fre~uency of the association of ~iabetps,dyslipi~emia an~ hypertension c~n probably lea~ to a nega~ tive reciprocal interacti0n. KeyWords: ~inbetes, ~yclipi~emia, hypf'rt ensi On
RESULTS OF THE EUREVIE STUDY: COMPARISON OF PIRETANIDE AND THIAZIDES IN MILD TO MODERATE HYPERTENSIVE PATIENTS -J-P Flllastre1, 0 Vasmant 2, M Lievre 3, 0 Charensonney2, L. lIon3, J·P. Bo,ssel3,J-P. Grunfeld4
GI9 OSCILLATORY INDEX OF ELECTRORETINOGRAM (01) IS CORRELATED WITH LEFT VENTRICULAR THICKNESS IN YOUNG UNTREATED HYPERTENSIVE PATIENTS. E. Bocin, A. Coscnzl, A. Sacerdote, R. Molino, ·N.Solimano,
uM.Zecchin, G. Bellini. Istituto di Medicina Clinica, ·Eye Clinic and ··Divlsion of Cardiology. Univenity of Trieste. ITALY
The authors have previously demonstrated that the 01 is early reduced in borderline hypertensive patients without retinal changes observed Ihrough fundoschopy. The aim of Ihis study has been 10 investigate whelher these changes are related with left ventricular hypertrophy. a recognised fcature of targel organ mvolvement in hypertension. Nme untreated borderline hypertensive patients (age 2UI yrs) were admilled to this sludy All subjects had at least three omce blood pressure measurement within one month, to confirm Ihe diagnOSIs of hypertenSIon. Silting blood pressure was measured for statlsllcal evaluallon with a mercury sphygmomanomeler after IOmln res\. Oseillalory potentials of electrorelinogram were recorded afier IS min rellnal mesopic adaptation. 01 was calculated by adding Ihe amplitudes of the wavwlels 01. 02 and 03 within the b wave of electroretmogram The Ihickness of the septum (LVS) and Ihe posterior wall (LVPW) of len ventricle was measured by means of M-mode and B-mode echoeardiography. Results are reponed as mean ± standard deviation: SBP(mmHg) DBP(mmHg) LVS (mm) LVPW(mm) OI(IlV) 133±6
90±~
1±O.2
09±O.2
92±23
An inverse relallon of 01 has been demonslrated with the thickness of both LVS (R= .0 705. p=O.03) and LVPW (R=oO 777. p. 0.01) by means of linear regression tes\. These results demonstrate that 01 are not only early decreased in young hypenenslVe pallents but are also strenghtly correlated with left venlrlcular Ihickness. a recogntsed marker of cardiac mvolvement in hypertension. playing a great prognostic role.
Key Words: hypenrophy.
hypertension, electroretinogram, left ventricular
1 HOpIIaI ell IloIsguiIalnl6-Nancy , 2 LaborIIOhs _-Paris, 3 SPC H6pItSI
Can1Ioioglqut-Lyon, 4 H6p,lal Necker·Pans
To compare the new loop-dlurelic piretanide 6 mg LP (PIR) with hydrochlorothiazide (HCT) 2S mg and a fixed combination altlzldespllonolactone (ALTISP) on the treatment 01 hypertenSion DeSign and methods: The study was conducted by 296 general practitioners (Gps) coordinated by 48 nephrolog'sts and 8 seOior Gps. Eleven hundred and ftve pat,ents wrth mild to moderale hypertensIOn entered a 3 week placebo runOing penod and 899 were randomIZed 11 a 6 month. double-blind, parallel group active treatmant penod. FolloWlng tha protocol reqUirements, HCT and ALT/SP were compared only w,th PIR USWlg the Dunnett's (continuous vanables) or chi-square (calegoncaJ vanables) tests !lmlIa: Pabent eharactenstlcs at OnclUSIOll were the foDOWIng: male 42%, mean age 56±12 years, systolic blood pressura (SBP) 166±13 mmHg, diastolic blood pressure (DBP) 101±6 mmHg. The 3 study groups were fairly comparable at base Ine No Slgnnicant difference was found between the groups tor the overall quellty of Ide. Changes (a) il main parameters between IncluSion and 1st (Ml) or 6th (M6) month VISits ere given in the teble PIR n =288 HCT n = 300 ALTISP n = 291 ·16.2 ± 13.3 -ISHii.8 -197 ± 12.2' aSBP Ml -20.7 ± 14.4 -20.1 ±13.0 -24.1 ±13.0' (mmHg) M6 -103±8.1 -109± 77 -12.1 ±7S' aDBP Ml -141±8.S -13.7 ±8.S -ISSi8.1 (mmHg) M6 to.002 ± 0.37 .0.27 ± 040" 0010±0.40" a Potassium Ml to.02 ± 0.42 .0.22 ± 047' 0004± 0.47 (mmofll) M6 -10.9 H7 -1.6± 10.8 -12.1 ±t.s' a Serum creatlnlllO Ml t11±104 t4.9± 133' tl0±13 blmolll) M6 Serum creatmlna 12" >120 Ilmofll (n) Ml ~.
M.mcnIl
·p.OOO5"p=O.Ol
For the !a11e anlihypertenslve effect, potassium concentration did not change il the PIR group, whereas it decreased il the HCT group. The fall il blood pressure were greater lithe ALT/SP than ilthe PIR group, but at the expense of 1r1 oncrease il serum creatinine. ~:
Key Words:
Clinical trials, antihypertensive drug Ireatment, loop diuretic, thiazides, potassium
123A